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Section C
Cultural Issues and Treatment
Photo by Gregory Bastien. Creative Commons BY-NC-ND. Retrieved from
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Cultural Issues I

Styles of emotional expression, eye contact, and body language,
vary across cultures

Language barriers may result in poverty of speech

Self-initiated, goal-directed activity can be expected to vary across
diverse settings, hence, disturbances of volition must also be
carefully assessed
3
Cultural Issues I

SZ diagnosed more often in individuals who are African American
and Asian American than in other racial groups
4
Cultural Issues II

Cultural differences must be taken into account when assessing
symptom expression
-

Ideas that may appear to be delusional in one culture (e.g.,
sorcery and witchcraft) may be commonly held in another
Visual or auditory hallucinations with a religious content may be a
normal part of religious experience (e.g., seeing the Virgin Mary or
hearing God’s voice)
5
Cultural Issues II

Across cultures, assessment of disorganized speech may be made
difficult by linguistic variations in narrative styles that affect the
logical form of verbal presentation
6
Treatment Strategies

Detection of mental disorder—case finding

Pharmacotherapy

Psychosocial family interventions
7
Treatment Strategies

Psycho-education

Adherence therapy

Community-based rehabilitation (CBR)

Cognitive behavioral therapy (CBT)
8
Pharmacotherapy

First-generation antipsychotics (FGAs)
-  Haloperidol and chlorpromazine

Second-generation antipsychotics (SGAs)
-  Clozapine and olanzapine

Meta-analyses indicate that FGAs and SGAs are equally effective in
treatment of main psychotic symptoms

Mood stabilizers

Antidepressants
Sources: Khan et al. (2008); Gaebel et al. (2007).
9
Complications

Suicide

Substance abuse

Crime

Comorbidities

STIs—HIV infection, syphilis, herpes, etc.

Medication side effects
10
A Psychiatric Ward
Photo by Etheldreda Nakimuli-Mpungu
11
Summary

Severe mental disorders occur globally, with prevalence rates
relatively stable

Culture can impact ...
-  Presentation, e.g., content of hallucinations and delusions
-  Degree of stigma and community acceptance
-  Choice of psychosocial interventions

Although lower in prevalence, people with severe mental disorders
should not be forgotten in program planning
12